[Bilateral lung volume reduction in patients with severe pulmonary emphysema]

For selected patients with severe pulmonary obstructive disease (COPD) and dyspnea despite conservative treatment, lung volume reduction (LVR) may to be of significant value as a surgical option. From May 1994 to March 1996 43 patients with COPD underwent through different procedures a LVR, 25 of them bilateral through median sternotomy or thoracotomies. With regard to chest computed tomography and perfusion/ventilation scan of the lungs the most affected portions are excised with the use of a linear stapling device. In all patients staplers was fitted with strips of bovine pericardium attached on both sides to eliminate postoperative leakage. There has been no early postoperative mortality (30 days). Follow-up ranges from 1 to 21 months. Preoperative and postoperative assessment of lung function tests, efficiency of respiratory pump, grading of dyspnea and life quality was prospective investigated. The mean improvement of FEV1 was 79%, PO2 at rest 8 mmHg. TLC has been reduced by 19%, RV by 31%. These changes have been associated with marked relief of dyspnea (grading of dyspnea reduced from 3.4 to 1.6) and improvement in exercise tolerance (6-min walk-test from 137 +/- 65 m to 265 +/- 175 m). Also significant changes the maximal inspiratory pressure, the mouth occlusion pressure and the transdiaphragmatic pressure as parameter of respiratory muscle function. Although the follow-up period is short, these results suggest that in selected patients with COPD, LVR improve lung function, gas exchange, efficiency of respiratory pump and quality of life and reduce the grading of dyspnea.